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29-176 (2) .,1.,-6.\_ k e • oa r . o : ui • In ' e lions an. tan. are s �- :_li — .. g • - _'"�= One Ashburton Place - Room 1301 Boston, Massachusetts 02108 • Construction'Supervisor License • License CS: 70626 • Restriction: 00 Birthdate: 812111971 Expiration: 8/21/2009 Tr# 3 ADAM A QUENNEVILLE 160 OLD LYMAN RD S HADLEY, MA 01075 • Update Address and return card. Mark reason for change • 0 Address ❑ Renewal 0 Lost Card DPS-cm ,, SOM- 07/07- PC8490 =;— B oard o Bui e la t � ons an. tans ar• s =j_(V O ne Ashburton Place - Room 13 • Boston, Massachusetts 02108 Home Improvement-- Contractor Registration Registration: 120982 • - Type: DBA Expiration: 3/25/2010 Tr# 264937 ADAM QUENNEVILLE ROOFING • ADAM QUENNEVILLE .. - 160 OLD LYMAN RD SO. HADLEY, MA 01075 .._ Update Address and return wl card. EmMark ployment reason f or Lost chanCg DPS -CA1 Cr 5OM- 07/07- PC8490 0 Address 0 Renea i� f Be it known that ADAM QUEN « .. 1 60 OLD ROAD _ f { t i SOUTH ` � 01075 2632 ,- . — t.i . ...-, " --,,,,, .:.3,...„,, ( 1: 1 is certified by th D t;, e4-)--4, r �C3 t r , ur . ' tect1on as a registered % « , i 1 iii ; , n ,. i t i HO I MPRO VEMEN T ONTR i t '.Regime n - i �,� 7 / 5920 , «, !?ANS7 !f » ADAM QUENI ROOFING . f � ti Effective: 12/01/2008 1 Y • Expirat�onr 1 / 30 / 2 00 9 4 . t� �- �;,� Jerrs F..arre Jr C st RX Date /Time 04/30/2009 14:41 1 413 538 6010 P.001 Apr -30 -2009 02:44 PM Remillard Insurance 1-413-538-6010 1/1 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID LL DATE(MMIDDIYYYY) ADAMQ -1 04/30/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Remillard Insurance Agcy, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 79 Lyman Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Hadley MA 01075 Phone: 413-538-7862 Fax:413- 538 -7179 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Ant mutual xeourauce Compaay INSURER B: Travelers Ins . Co . Adam Quenneville Roofing & Siding NSURER C: Scottsdale Ins Co. 160 Old d Lyman Road INSURER(); South Hadley MA 01075 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. INbN AMYL, POLICY EFFECTIVE POLICY EXPIRATION LTR NSRC TYPE OF INSURANCE POLICY NUMBER DATE(MMIOD/YYI DATE(MM /DDNY) LIMITS GENERALLIABIUTY EACH OCCURRENCE 31000000 - C X COMMERCIAL GENERAL CLS1517923 06/23/08 06/23/09 PR EMI S ES(Ee oc curence� 3100000 CLAIMS MADE r I -' I OCCUR MED EXP (Any one person) 35000 PERSONAL SADVINJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN% AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 32000000 — 1 POLICY I (i LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 B ANY AUTO BA7450L946 /01/08 11/01/09 (Eaaocident) _ ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS (Par accident) ( 1 - 1) ;) PROP DAMA S (Per a ccid en t ) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT GE S ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S _ EXCESS/UMBRELLA LIABILITY _— EACH OCCURRENCE S ^I OCCUR ( CLAIMS ADE AGGREGATE S S _ DEDUCTIBLE S RETENTION $ _ $ — WORKERS COMPENSATION AND X I ORY L Mf i I I 01 H- TORY LIMITS X ER A EMPLOYERS' LIABILITY AWC701286101 04/29/09 04/29/10 El_ EACHACCIDENT $1000000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $ 1000000 Hges, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY UMtT 51000000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS \\"/ • CERTIFICATE HOLDER CANCELLATION TOWNLVD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AU7ZED REPR SENTATN ACORD 25 (2001108) 4E414' © ACORD CORPORATION 1988 is i jz ...7,''' ( � k r •• up ice o f i n vca L u....v,.. ! --600 Washington Stree 741; =" RIM : Boston, MA 02111 www. mass.gov /dia Workers' Compensati - Zn1u a Affidavit: Builders! ontrac ors/El ectriciaus)Plumbers Applicanf. Inforlmatioxl Please Print Lezibly . • • Name (Bu stress /Organizationllndividual): Q' Cjit.),■nrs6 I it 4 i ' \C� Address: 1 - C vj' w 1-- . .► . e, • • V 1 • City /State /Zip: ' A"8 •_ 111 Oi fl Phone #: 1 1 3 53L 156 • Are yo an employer? Check the appropri bo'x: ' : 'type of project (required): 1. Tql am a employer with em p 15 4 ❑ 'l •arn a g eneral Contracto and I 6. ❑ New construction employees (HI and/or part- time)." • • have hired the sub -con. - ctors 2. n I am a fole proprietor or partner- listed on the attached sh et, t 7. El Remodeling . ship an have no employees These s contractors h: ve 8. ❑ Demolition • . working for me in an y ca p aci tY• workers' comp. insuran e. 9. ❑ But7ding,addition [No workers' comp. insurance 5. El We are a corporation .. d its • required.) . officers have, exercised .. it 10.❑ Electrical repairs or. additions 3. n I am a homeowner doing all wotk . right of exemption per . GL 11 Plumbing repairs or additions myself [No workers'• comp. c. 152, §1(4), and we h.ve no ! 12.f-repairs insura4cc required.] t • employees. [No worke .' 13,0 Otb • - . +' comp. insurance reyuir. d.] Any applicant ' a checks box #1 must also fill out the section below stowing their workers' ompcnaation ..!icy information. • • t florneowncrs o submit this affidavit indicating they arc doing all aork and then'hire outsi. c contractors •• .t sub}nit a new aft davit indicating such.. . t Contractors ih c heek this box moat attached an additiOIial sheet ehowiag of the a . atractors .4 their workers' comp, policy informatioq. I am: an emp!pyer that is providing workers' compensation insurance for y employ: es.' Below is{ the policy and job site • information. i 1 1 ( � Insurance Company Name: A) t il dio • • Tt"s g o ia ail �r-a —a sy P Policy # or Self -ins. Lic, #: Exp' : lion Date: , Job Site Address :_ l �i�� • - 'S L�t .e l�Gl - � City /S . telZip: \ ' A ci....:N /»-< k CO.() Attach a c op y of the workers' 'compensation policy declaration page (slowing di: policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL e. 152 c :. lead to 'se imposition of ctuni ial penalties of a fine up to $1; and/or-one-year imprisonment, as.wcll as civil penalti . in the fo .. of a.STOP•WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this_ • • tatement ;lay be forwrcled.to the Office of Investigatio4 of the DIA for insurance coverage'veri ieation. • . • • • • I do hereby ettify under t ' pales and penalties of perjury that the info • n pr, ., ed above is true and'ebrreet Signature: '',e.'" . Date: ? - - Oi • • Phone #: it f. ..�t3�.¢ k.--59i.5.6 � • •p Official u se on Do not write in t ' area, to be completed by city town offic ,L •• . City or Town: - • Permit/Li • ense # • is . Issuing )utbority (circle ope): • . • • . :. . 1. Board,,of Health 2..Building Departm eta 3. CityiTown'Clerk 4 Electric. Inspector 5. Plumbipg Inspector 6. Other i . Contact Person: ? '1. one #: i . A D = ARA VISA Mas E - DIIC•VER Q U E N N E fl L L E www,1800newroof.net ROOFING & SIDING, INC. 160 Old Lyman Road, South Hadley, MA 01075 We Are Licensed JU L 1 -80b-NEW-ROOF Fully y Insured Email: info @1800newroof.net Factory Trained MA Construction Supervisors Lic. #070626 MA Registration #120982 Factory Certified Installers Member of the Home+Builder's Association of Western Mass. CT Registration #575920 Member of the Building_ & Trade Association Member of the Better Business Bureau P.P.C. 38710 Proposal Submitted To: Date Phone #'s ;mac/ Work: d 1 f e .7� H:(,3) -- i 6/3 Cell: Strre t / / Email: n / L City, State, Zip Code Special Requirements 73-3 l h+, '�'/l - 4, M4 0/06i ,U.E CN�r"✓E Y (// 3' 'i 6 Xc- Complete Roof System M We shall acquire all appropriate permits for all work ® Home exterior and landscaping to be protected ® Entire existing roofing materials to be removed to existing decking Deteriorated existing decking will be replaced at $3.47 per sq.ft. [j Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes, skylights and sidewalls ® Install (15 lb. felt / ynhetic underlayment over remaining decking area [E Install Metal drip edge at eaves and rakes / 5 ") white brown / copper) [ Install manufacturers starter shingle on all eaves and rake edges FA Install new pipe boot flashing (standard opper) [ Install new step flashing where necessary standar copper) M Install Hand nailed rigid baffled continuous ridge vent ❑ Install proper soffit ventilation Shingles: (6 nails per shingle) / G .- F Shingles E] 25 year U 30 year II] 50 year Color hcg ave GA F Ridge cap shingles Warranty Options: g We guarantee our workmanship for 10 full years (see our warranty coverage) ❑ GAF ELK System Plus warranty ❑ GAF ELK Golden Pledge warranty Chimney Options: ✓ Lead Counter Flashing ❑ Water Seal & Tuckpoint � Rubberized Crown 111 Metal Chimney Cap We Propo to furnish materials and labor - 4mp+e1._ �cddrd • w i th above, specifications for the sum of: ?7 Total S le rice' $ 7U V C Down fayment $ 300 0 Upbn Completion $ 1 70 V O ACCEPT E OF PROPOSAL: The above pri sp ci s an do i tion L are • sat and are hereby accepted. You are authorized to do work as specified. Payment- iIill be 1/3 down upon - signing, and balance due upon completion. Unpaid balances shall accrue with interest at 18% per annum. -- Purchaser(s) will pay for all costs, expenses and reason- able attorney's fees incurred by Adam Quenneville Roofing and Siding, Inc. to recover any sums due under this contract. Date: r Phone # �°�-J / �) ' C Signature: �� natu / //` /a Estimator's Si �G Date: 7/ `1 9 ATTENTION HOMEOWNERS: Please cover all personal belongings in the attic, garage or storage areas due to the possibility of roofing debris or dust coming in through cracks of the wood. Adam Quenneville Roofing and Sidings will not be responsible for debris or dust in the attic or storage areas. 1/09 -- '"A ' i�' ,r • n^rr�n. _,•, ,'FMrL u:IR!:30u�^ • . : r k.•'i: Gass v, ' -' 21 . tl f g' • �; ' r�r. :�._!L� .L'!,17"' :li � irf. sSER OM ' e e 17' sR ilC R f Va'G S1;; a 8.1 Licensed Construction Supervisor: Not Applicab e Name of License Holder : 0 - 7 u (Q a,Y Adam Quenfeville Roofing & Siding, Ilse: License Number 160 Old Lyman Road - U1 Address �tl Expiration Date Si.�ure Telephone Not Applicab e l� Company Name Adam uuennevllle Rouliny & Siding, lira. — Registration Number 160 Old Lyman Road Smith Hadley . A 0E07 Address Expiration Date • Telephone 3 3CtSy'S .._. ......>._... - a :_. _ ,...... : :r.n f - �. . 4 .r: ,,, .,. M1 :'l.P2 :.1,' :, ar'r .ir'�r,y,;...., Lr: ,, :: rrg:'., :•, : :y,N., r';'� .ear ! F! , v° r. .y�ry :f.;r :r; = �s�s�;�r - y.r�� .;, ,��.�., :;�;h.. T!'+5 =!•• � �:I. �. -ate, T a a"�jP.... ,�•r! :ruart.,'. H •r - .. SEG !! .[ ; M `A ifO.N,i41 / t 'C 5E1IUMP � .. 2 , � - ' :rE -�.. ...y...�.:.,. . -r.,. .,._. : -... ,.... . . .. . ^' ?.gu ,,."tv!Pal�'n�,?' A. ^. :.;�!?�'y �� = "' .. r .. ( _ MM ,�� . :.s.�:. i�mi;. "• �- � °;'..' :"ai :':i���5 J..rl''.d,' +� Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes No ❑ • The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or :two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, proviced that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s).who own a parcel of land on which he /she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. . As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liatility of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perfonn for you under this permit.. . The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Bu lding Code, City. Of._ Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Arnotated. Homeowner Signature . • / • • • k"f * 1 i 1 F !`v4`•* „ :,,i, '1 :y, gift::: r a . a y a•�. . ,, I x + r 'S F r ya r ILLm IEa 1� w 7t� I plan! • �i1 d Q g "js.� ' ft ' '�, o o ©, h . • a ay e u I� • e ∎ ir` . F_7_�, a r ';.°Jb- o .,- ' r e... -°4`' 2::9.441644- 4 11fll • '.a W4 •�.e o'rr,'' 33 _ dy : '' r " ` .,irk.., ,n "Iltirx _ . -., z. • ._. New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing . 1 Or Doors 0 , Accessory Bldg. ❑ Demolition❑ New Signs [ J Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work: 8 F 1 -`c ' f' st 0 F Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative O Renovating unfinished basement Yes No Plans Attached Roll 0 - Sheet ❑ • 67.a Ne eLM d a: a. qtr n b e i Slibr h:a>asf tiR ,rn=pWe x ff o< i x: a. Use of building : One Family Two Family . ___ Other. b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. bimensions e. Number of. stories ?... . • f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masch,eck Energy Compliance form attached? h. Type of construction i. Is construction within .100 ft. of wetlands? Yes _ No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor' below finished grade k. Will building conform to the Building and Zoning regulations ? • Yes No',. I. Septic Tank City Sewer Private well _ City water Supply 1 Y �,ER l o Im "`� . Ll • . '4 ,9R 13TI sP � iT} tkr.„- I, , as Ow -ier of the subject property hereby authorize to act on my behalf, in all matters relative to work. authorized by this building permit application. Signature of Owner 1 Date I, - A fi S' D.1:, G'1uv,, c (Co_ t_no , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate to the best of my knowledge and belief. Signed under the pains and penalties of perjury. A 6_ Ct 1"A 0, -V\ N., ,A. Print Name ��' / 7 70I Signature of Owner /Agent Date , — for ? f Y City of Northampton X 614 ,c' Building Department v' , i ! y�'i'' ` :`. • 212 Main Streetdr'rr�'�° �r 4_. 1 5 2 , - „ 09 Room 100 �' :,- g �1 i ��E, tl • Northampton, MA 01060 g� +.�, 3 1 1 N) JLW phone 41'3-587-1240 Fax 413 587 1272 . „�-s Q.r� �. F ,� ;. .. g� APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWuu FAMILY DWELLING • L.h ECT l _ , 5;1 T ��ff �1i �.f�`� �V 1 ��`�fl`A N w... ,"'� 7 r Z IYS'kux' , n , i4- Y J C� i { �' .hM'IN 5 ) { •$ . 7 ; ��'{ 74 s.ecta '0.07' pFetedit 176.41 6;, q . r 1.1 Property Address: �, at ,* - �' ” i o a t"s 4 J • . 2�7b Cam- ! 4, y o , 4 , ,,f . y n ' , , y4 ( W r te - V ` - xg;- e 4 7,or Or':> 'ti.. 1. ty. , anyi `t. .° `L�. : 1 r, : rZone� .� i 4 ,04 fii y D .rGCtr �" � y' • Lam . �"r: sxN .+�, E ` ' r *„...-',•->•W t"' T ,, - vt+i � "� -. % r ' y . ,5, 1-M . : '*0r 7 k4rtl< i , y 1 J �! a , 1 , r•° • „�..'�r1. 4. a ^4` "'T ., ,Elm, S:t Rittrtct ' { .' Ors' � q, , a ..4F cf + 7r. ,: 'EG TI 2 ' � Y , i1P. W ('E' . i' l�A: TkW - O , - ' v rg -4 `' EN'T • � �X` w r''�i.Y:.� �:s gh ' Aa i • — h e^�' " t. d+�k �'.;sN"�?F §aaar'., � r ; _'+�p,..�:�: , ,e?7 ,;: �; ., ,.r ,'. ,r. ?�.• .:.�.. .. .��,: ",. :.T r+ t:i�u':'d. °J- '..$: *�. :.d;i�.kr :,i "��.. ....gym. _:,;�':i,�r, 2.1•Owner of Record: . • . • . 1 C 63 P- ILcA'■dlk - C cri poz\i„.....,A r(A._ Name (Print) Current Mailing Address: , • • Te(ephone 15 i �, LI `t 1 Signature , • 2.2 Authorized Agent: .. • - • A dam Quenn eviile Roofing & Si °gii.: • - Name (Print) 5 Current Mailing Address: / South Hadi f i n7„ Signature =.0 '!' �'h"$. M7rro {1,1�14iG1 „r, �: q j� �:�• !A sir h ,.. -n _ _._ d S h'AI H '� %a Ia 4 �,�5 �"C:7i N .3 � ggin i"A E'D �: O'N'S�f CN? . �y 0 w1'r5 s , - ,�-:�.. - rw. '....,•n.exw,- , ....�.0 xmu,^c.,:.hL �!a•x a:;;,.:w , m �;na ws Y , dM Item Estimated Cost (Dollars) to be ®;facial[ =n(n '` completed by permit applicant R .,. , .. 1. Building (a Building Permit Fe . f . F 2. Electrical (b).E.. oh stiMated. T Gost,of Construction;,frorm::.;(6'). •, • _ 3. Plumbing Building Permi't-F'e'e .. 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) — 70 \-to. u,. Check.. Number • . .. ct This Se ionFor Offi ial Use'O;nly. _ , .• 8u(1d1ng.Pe�iri • Date!;Issued. ' p a H 1 r r t t P::•;'I, . !0 m i r3_ature. ” Buis i , j ,.. ,� d rig,,Gofi rni —, ons B}.,ildiri ..p to ' • 183 BROOKSIDE CIR BP- 2010 -0053 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29 - 176 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit # BP- 2010 -0053 Project # JS- 2010 - 000062 Est. Cost: $7040.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE Lot Size(sq. ft.): 16988.40 Owner: PERET WALTER JR & JUDY A Zoning: URA(100) / /WSP II Applicant: PERET WALTER JR & JUDY A AT: 183 BROOKSIDE CIR Applicant Address: Phone: Insurance: 183 BROOKSIDE CIR FLORENCEMA01062 ISSUED ON: 7/16/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP AND RESHINGLE POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo